Freud's Unwritten Case:
The Patient "E."

Details of Freud's 5-year treatment
of a male patient are reconstructed from the Wilhelm Fliess correspondence. The
patient, "E.," links Freud's therapeutic work and his self-analysis
during the transitional years between 1895 (Studies on Hysteria) and
1900 (The Interpretation of Dreams). "E."'s therapy stands in
apposition to Freud's own anxiety-neurotic difficulties in the late 1890s and
aids in understanding Freud’s nascent theories of neurotic etiology,
psychoanalytic interpretation, and transference.

This manuscript forms part of my own extended examination of the personal,
clinical, and theoretical sources of Freud's early work with psychoanalytic
concepts (cf. Davis, 1990, 1994).
In this paper I relate Freud's self-analysis following his father's death in
late 1896 to his increasingly rich counter-transferential involvement with a
male hystgerical patient whom he treated from 1895 to1900. In the period of
anxious introspection surrounding the death of his father in 1896, Freud
confronted Oedipal and pre-Oedipal issues in his own personality, tested many
of these in his nascent clinical practice, and outlined the theoretical and
clinical consequences of his new ideas in letters to Wilhelm Fliess (Anzieu,
1975/1986; Masson, 1985). At a theoretical level the major change in Freud's
thinking during this period involved a movement away from a causal model for
the effects of childhood trauma in the formation of adult personality and
neurosis -- the so-called "seduction theory -- and toward psychoanalysis
as a hermeneutic discipline in which the subjective meaning of experience --
whether real or fanciful -- is the basis for understanding.

Psychoanalysis, as a related body of clinical technique, interpretive
strategy, and developmental theory, took shape in a decade centered on 1900.
The years preceding Freud's completion of The Interpretation of Dreams (Freud,
1900) and spanning his writing on "anxiety neurosis" (Freud, 1894,
1895a, 1895b), the publication of Studies on Hysteria (Breuer &
Freud, 1895), and the papers outlining the "Seduction Theory" (Freud,
1896a, 1896b, 1896c) and the role of sexuality in neurosis (Freud, 1898), are
critical for an assessment of the process by which psychoanalytic psychology
took shape. In his intimate correspondence with Fliess (Masson, 1985), Freud
first shows himself (from the inception of the relationship in 1887 to roughly
1894) preoccupied with impaired sexual functioning as a common source of
anxiety and therefore of "actual" (as contrasted with psycho-)
neurosis. Themes of desire for fertility and nurturance, of a contradictory
ambivalence toward fecundity and progeny, and of the traumatic effects of
incomplete sexual satisfaction recur in both the published and the unpublished
early Freud writings, and these core issues appear at several points
imaginatively linked to abortion and to infanticide.

Freud's early theorizing about the causes of adult psychopathology assumed
that both forgotten childhood trauma and a variety of adult stresses could
cause neurosis, and that their influence was additive -- a significant
childhood disposition or a congenital physiological weakness could lead to the
emergence of a psychoneurosis as a response to average levels of adult stress,
while exceptional stress could produce an actual neurosis even in the absence
of clear disposition. Since the most prevalent and problematic adult stresses
where neurasthenia and anxiety neurosis were concerned were in the realm of
sexuality, Freud studied the details of sexual satisfaction and frustration
among his largely Victorian bourgeois peers. By the middle of the 1890s he had
become an advocate of sexual expression and orgiastic satisfaction for both
sexes.

Freud's concern with the psychopathological effects of sexual frustration on
the male were also personal, on the evidence of the Fliess correspondence and
his self-analysis as reflected in The Interpretation of Dreams (Freud, 1900).
His own attempts in the 1890s to limit his family -- out of both concern for
Martha's health and worry over costs -- led him to experience a variety of
psychosomatic symptoms (Anzieu, 1975/1986; Davis, 1990; Schur,
1972).

By the middle of the 1890s Freud was preoccupied with the psychoneuroses,
and in his 1896 articulation of the "Seduction Theory" he attributed
these to the results of prepubertal trauma, usually involving sexual abuse of
the child, who thereby became disposed to neurosis as a result of even normal levels
of adult stress (Davis, 1994; Freud,
1896a, 1896b, 1896c). Freud's primary concern in these early psychiatric or
neuropsychological works was with the specific etiology of the common neurotic
disorders, i.e., with the developmental preconditions under which common
life experiences such as assumption of regular sexual intercourse after puberty
would give rise to distinctive psychopathological conditions. The increasingly
problematic epidemiological and clinical implications of the seduction theory
led to a fateful reorientation of Freud's thinking in 1897 (Freud, 1897), after
which a traumatic etiology became merely a special case of the more
comprehensive psychoanalytic view that it is the psychodynamics and not the
factual content of childhood experience that forms the basis for personality
development (see Laplanche, 1987/1989).

I believe that close examination of Freud's evolving clinical methods and of
his transferential involvement with the far more nuanced psychodynamics of
recovered and reconstructed childhood and adolescent memories during the late
1890s is essential if we are to understand the most revolutionary ideas behind
psychoanalysis, viz. those advanced in The Interpretation of Dreams.
The discovery that during the critical 1895-1900 years Freud psychoanalytically
treated a male neurotic with symptoms and personal history strikingly resonant
both with his own nascent thinking about Oedipal and pre-Oedipal psychodynamics
and with aspectrs of his self-analysis in the aftermath of Jacob Freud's death
was certain to intrigue me.

Herr "E."

Although the patient labeled "E." in Freud's letters to Wilhelm
Fliess was clearly among the most important -- and the most persistent -- of
the cases treated during the 1890s, almost nothing is known of his personal
circumstances. The case has been the subject of one published paper other than
my own (Rosenblum, 1973)3 and of several discussions in biographical
work on Freud (see Anzieu 1975/1986, pp. 521-525 and passim; Rudnytsky,
1987; Schur, 1972). This male analysand, to whom Freud made apparent reference
some 16 times in the Fliess correspondence (Rudnytsky, 1987, p. 365), is
apparently first mentioned on October 31, 1895:

My "bashful" case
must be finished by the end of '96.4 He
developed hysteria in his youth and later showed ideas of reference. His almost
transparent history ought to clear up a few disputed points for me. (Masson,
1985, p. 148)

The ironic epithet "bashful" refers to a contradiction Freud did
not state explicitly in the letters until 1899, between "E."'s
inhibited social behavior and his obsessive fantasy of ravishing every
attractive woman he met (see below). Freud's-overly optimistic-prognosis at
this point reflects his interest in articulating an etiology for male as well
as female hysteria (see Freud, 1896c). He was also still
working within the assumption articulated in his work with Breuer, namely, that
bringing repressed early traumatic material to consciousness allows
"abreaction" and quick remission of symptoms (Breuer& Freud,
1895, pp. x-xi, 157-159). A note three days later, on November 2,
probably also alludes to "E." (see Anzieu, 1975/1986, pp. 161, 190):

One of the cases has given me
what I expected (sexual shock-that is, infantile abuse in a case of male
hysteria!) and ... at the same time a working through of the disputed material
strengthened my confidence in the validity of my psychological constructions.
(Masson, 1985, p. 149)

From its early months, therefore, "E."'s treatment was seen by
Freud as relevant to the key issues of male hysteria and early sexual trauma.

The following year brought Draft K (Masson, 1985, pp. 162-169), with its
rethinking of obsession, paranoia, and hysteria, and Freud's description (March
16, 1896) of setting down on paper, "just as a young poet tends to
do," a title for a series of "Lectures on the Major Neuroses
(Neurasthenia, Anxiety Neurosis, Hysteria, Obsessional Neurosis)". These
plans seem to have in fact produced the three papers of 1896 in which Freud's
new specific etiological theory of pre-pubertal sexual trauma was advanced; and
on May 17 (Masson, 1985, pp. 187-190) Freud diagrammed a detailed, epigenetic,
conception of the critical periods of childhood, the defensive legacy of each,
and the adult psychopathology to which it was precursor.5
In the same March letter, however, Freud had noted of the lecture project that
"behind it looms a second and more beautiful work Psychology and
Psychotherapy of the Neuroses of Defence for which I am allowing myself
years of preparation and into which I shall put my whole soul" (Masson,
1985, p. 178). This latter work, of course, never materialized. Instead, after
Jacob's death, the turn from the seduction theory, and re-intensification of
"E."'s therapy, we get "the dream."

"E." also seems to be one of the patients referred to a year later
(in a letter written October 9, 1896), 2 weeks before Jacob Freud's death.6
In this period, and during the year of intense self-analysis and
theory-revision following his father's death, Freud had only two cases -- one
of them "E." -- under regular analysis. Both were male neurotics
showing mixed hysterical dynamics with obsessive agoraphobic symptoms. Freud
indicated that he was "now very satisfied with [his] two cases," that
in another "year or two" he would be able to explain their neuroses
"in formulas that can be told to everyone" (Masson, 1985, p. 200).7
Even at this point the treatment of these patients was associated with Breuer,
whom Freud mentioned a sentence later having seen under tense circumstances at
the home of one of the latter's patients. On January 24 of the next year
"E." was named for the first time (see Rosenblum, 1973, p. 51), was
credited with a fantasy supporting Freud's hypothesis linking money to feces,
was was linked (apparently through a recollection of a nurse-maid) with Freud's
sudden interest in witchcraft as an anthropological prototype of sexual
neurosis (Masson, 1985, p. 227).

Freud may well have included "E." among the eighteencases of
hysteria he mentioned having treated in his famous "Etiologyof Hysteria"
talk in May (Freud, 1896c), although no identifyingdetails are mentioned. It is
clear from his comments to Fliessthat at several junctures Freud believed the
therapy with "E."was providing evidence to illustrate and corroborate
this revisedtraumatic theory of neurotic etiology. As of 1896, for
example,Freud argued that hysteria was the post-pubertal result of havingplayed
a passive role in childhood sexual episodes, while obsession-compulsion
suggested that the (somewhat older) childhad been moved to active
arousal by childhood seduction. Draft L., of May, 1897, includes a reference to
patients who "cling to their suffering" (Masson, 1985, p. 242). Freud
had concluded by this time that servant girls and nursemaids were often the
most significant infantile lust-objects, and his description of
"E."'s early fixation on his nurse is strikingly similar to what he
revealed to Fliess in October, 1897, about the role played in his own case by
his nurse (Masson, 1985, pp. 270-273; see Rudnytsky, 1987, chap. 3).

Freud's discussion of "E."'s "anal" symptoms of doubt
and punctiliousness represents perhaps his first move toward a psychoanalytic
theory of character. The case had apparently continued more than 2 years by
this time, although Freud had expressed the hope the previous January that at
least one of his two cases would be completed by that Easter. The clinical
material Freud obtained from "E." included both hysterical symptoms (e.g.,
"E."'s characteristic nervous sweating) and obsessive thoughts (e.g.,
the fear/wish that he would sexually assault someone at the opera), and hence
"E." stimulated Freud's thinking about the differential etiology of
the neuroses.

E-tiology

By the third year of "E."'s treatment the goal of the anamnesis
had shifted from the recovery of particular early traumatic memories to
inference of childhood psychodynamics (emotional connections among memories),
and the resulting clinical process seemed interminable (see Davis, 1994).

As Freud's enthusiasm for infantile fantasy as the core organizing principle
in neurotic etiology (and personality development generally) gains conviction,
he produces the rich corpus of dream-text whose analysis allows him at last to
pen a great work, "the dream," e.g., June 20, 1898:

The psychology is proceeding in a
strange manner; it is nearly finished, composed as if in a dream and certainly,
in this form, not fit for publication, nor intended for it, as the style shows.
I feel very timid about it. All its themes come from the work on neurosis, not
from that on dreams. (Masson, 1985, p. 318)

"E." and Freud

If the early phase of "E."'s treatment provided valuable grist for
Freud's pre-psychoanalytic theorizing, the concluding months seem to have
confronted him with transferential material of a strikingly psychoanalytic
sort. In February, 1899, Freud introduced a discussion of "E."'s core
symptom into an important letter in which he drew an analogy between dreams and
hysterical attacks as expressions of paired oppositions in which the meaning
"is a contradictory pair of wish-fulfillments" (Masson, 1985, p. 345):

Do you know why our friend E.,
whom you know, blushes and sweats as soon as he sees one of a particular
category of acquaintances, especially at the theater? He is ashamed, no doubt
-- but of what? Of a phantasy in which he figures as the deflowerer of every
person he meets. He sweats as he deflowers, working very hard at it. An echo of
the meaning [of this symptom] finds a voice in him, like the resentment of
someone defeated, every time he feels ashamed in the presence of someone:
"Now the silly goose thinks I am ashamed. If I had her in bed, she would
see how little embarrassment I feel!" And the period during which he
turned his wishes into this phantasy has left its mark on the mental complex
that produces the symptom. It was during the period when he studied Latin. The
auditorium of the theater reminds him of the classroom; he always tries to get
the same regular seat in the front row. The entr'acte is the school
"breather" [Respirium], and the "seating" stands for
"operam dare" ["to make every effort"] in those
days. He had an argument with a teacher over that phrase. Moreover, he cannot
get over the fact that, later, at the university, he failed to pass in botany;
now he carries on with it as a "deflorator." (Masson, 1985, pp.
345-346)

Rudnytsky (1987, p. 60) noted how closely the account of "E."'s
botanical symbolism here replicates Freud's own as reported in the (disguised)
case material of his paper on screen memories (Freud, 1899), and in the
associations relating anxiety over performance in high school botany to
masturbation and sexual intercourse in the "Dream of the Botanical
Monograph" (Freud, 1900, p. 171). Patient and therapist enjoyed a
remarkable congruence of psychodynamics, and the subjective associations of
each informed the ongoing therapeutic dialogue.

The next apparent reference to the case, on December 21, 1899, is the one
tied directly to Freud's own dream of being billed in connection with his
father (see below), which he had apparently reported verbally to Fliess:

I am not without one happy
prospect. You are familiar with my dream which obstinately promises the end of
E.'s treatment [among the absurd dreams], and you can well imagine how
important this one persistent patient has become to me. It now appears that
this dream will be fulfilled. I cautiously say "appears," but I am
really quite certain. Buried deep beneath all his fantasies, we found a scene
from his primal period [before twenty-two months] which meets all the
requirements and in which all the remaining puzzles converge. It is everything
at the same time -- sexual, innocent, natural, and the rest. I scarcely dare
believe it yet. It is as if Schliemann12 had once more
excavated Troy, which had hitherto been deemed a fable. At the same time the fellow
is doing outrageously well. He demonstrated the reality of my theory in my own
case, providing me in a surprising reversal with the solution, which I had
overlooked, to my former railroad phobia. For this piece of work I even made
him the present of a picture of Oedipus and the Sphinx.13
My phobia, then, was a fantasy of impoverishment, or rather a hunger phobia,
determined by my infantile greediness and evoked by my wife's lack of a dowry
(of which I am so proud). You will hear more about this at our next congress
(Masson, 1985, 391-392).

This remarkable passage places "E." at the center of a web of
significance for Freud: half-remembered pre-oedipal experiences of erotic
longing and stimulation, and an adult neurosis combining sexual frustration and
fear of impulses. A "surprising reversal" indeed, as the early
maternal experience by which Freud had been haunted in his self-analysis
resonated with "E."'s material, although we never learn the details relating
"E."'s neurosis to Freud's anxiety concerning railways. Freud's
impatience to successfully conclude the treatment is also manifest. The
following month Freud reported that "E."'s "second real scene is
coming up after years of preparation," that he might be able to confirm
the details by asking the patient's older sister, and that he suspected a third
scene concealed behind the second (Masson, 1985, p. 395). Here the parallels
between "E."'s analysis and Freud's own are explicit. Both displayed
pre-oedipal ties -- involving in both cases a "seductive" nursemaid
-- which left greedy ambition as characterological evidence. Both neuroses
expressed themselves partly in a fear of travel by train, and each man's
analysis was to be represented by the fateful encounter of Oedipus with the
Sphinx.

This letter reports the most remarkable statement of counter-transference in
Freud's writing: therapist listens with growing excitement as patient's
anamnesis approaches material which will exactly meet the requirements of a
theoretical puzzle, compares the material produced to his own fantasies of
archeological revelation, insists (against the subsequent clinical evidence)
that the therapeutic results are wholly positive, credits the patient with
clarifying his own infantile neurosis, and rewards him with a copy of a
secretly meaningful work of art! The extent of Freud's identification with this
patient is underscored by his awarding "E." a picture of Oedipus and
the Sphinx. This was Freud's signature image, the scene he placed at the foot of
his analytic couch (see Engelman, 1976, Plate 12) and selected as his own
bookplate -- the same image Jones and the rest of Freud's inner circle chose in
1906 as the subject of his 50th birthday medallion. Freud had as a teenager
identified himself with the man "who divined the famed riddle" (see
Jones, 1955, p. 14; Rudnytsky, 1987, p. 62; Sulloway, 1979, pp. 479-480), and
as a middle-aged man he found in "E." both an echo and a verification
of his self-analytic insight. Furthermore, the "transferential" roles
for Freud of "E." and of Fliess seem increasingly similar, and
"E."'s termination may have enabled Freud's distancing himself from
Fliess, as Anzieu suggested (1975/1986, pp. 521-525; cf. Rosenblum, 1973).

Two months later, in March, 1900, Freud's etiological argument seemed to
have collapsed in "E."'s case, however, and he was consumed by doubt:

After last summer's exhilaration,
when in feverish activity I completed the dream [book], fool that I am, I was
once again intoxicated with the hope that a step toward freedom and well-being
had been taken. The reception of the book and the ensuing silence have again
destroyed any budding relationship with my milieu. For my second iron in the
fire is after all my work -- the prospect of reaching an end somewhere,
resolving many doubts, and then knowing what to think of the chances of my
therapy. Prospects seemed most favorable in E.'s case -- and that is where I
was dealt the heaviest blow. Just when I believed I had the solution in my
grasp, it eluded me and I found myself forced to turn everything around and put
it together anew, in the process of which I lost everything that until then had
appeared plausible. (Masson, 1985, p. 403)

The patient is mentioned again in the letter of April 4th, where Freud noted
that "E. will terminate treatment at Easter, having benefited
enormously" (Masson, 1985, p. 408). The next letter, 2 weeks later (April
16, 1900), contains the final reference to "E." It is postmarked
Vienna and begins with an ironic "greeting as ordered from the land of
sunshine," and the admission that, "once again, I did not get
there" (Masson, 1985, p. 408). After explaining that his announced trip to
northern Italy had been cancelled because of bad weather, his companion's fear
of the long return trip, and the illness of his children, Freud discussed
"E."'s long-awaited termination:

E. at last concluded his career
as a patient by coming to dinner at my house. His riddle is almost completely
solved; he is in excellent shape, his personality entirely changed. At present
a remnant of the symptoms is left. I am beginning to understand that the
apparent endlessness of the treatment is something that occurs regularly and is
connected with the transference. I hope that this remnant will not detract from
the practical success. I could have continued the treatment, but I had the
feeling that such a prolongation is a compromise between illness and health
that patients themselves desire, and the physician must therefore not accede to
it. The asymptotic conclusion of the treatment basically makes no difference to
me, but is yet one more disappointment to outsiders. In any case I shall keep
an eye on the man. Since he had to suffer through all my technical and
theoretical errors, I actually think that a future case could be solved in half
the time. May the Lord now send this next one. ...
Occasionally something stirs toward a synthesis, but I am holding it down.
Otherwise Vienna is Vienna, that is, extremely disgusting. If I closed with
"Next Easter in Rome," I would feel like a pious Jew. So I say
rather, "Until we meet in the summer or fall in Berlin or where you
will." (Masson, 1985, pp. 408-409)

Freud was thus finally able to report the end of "E."'s treatment
-- albeit somewhat short of complete symptom remission -- as an Easter event.
Coincidentally, he confessed yet another postponement of his
so-deeply-desired Italian travel, which he sarcastically compared to the
Passover promise, "Next year in Jerusalem." The irony with which
Freud reported his recurrent failure both to complete planned Italian travel
and to remove the patient's symptoms is revealing. At several previous points
coincident mention of this case and of planned travels had suggested a
connection in Freud's mind between the patient's anamnesis and his own
self-analysis. Exhilarated at completing his grand, self-revelatory Interpretation
of Dreams,Freud's confidence about his patient had been unbounded;
but as doubt and disappointment over the book's reception mounted, he also lost
clarity about "E." The sense of "E." as a stand-in for
Freud himself, who could not travel to Rome until the oedipal current in his
own personality had been dealt with seems here a strong preconscious current
(see Harris & Harris, 1984; McGrath, 1986).

We are left to speculate why this particular case proved so engaging and yet
so frustrating to Freud and in particular why, despite recurrent references to
details of "E."'s analysis relevant to his theorizing, almost nothing
in the way of specific case material from this analysis ever found its way into
Freud's published writings.14 On the basis of the varied
contexts in which Freud recalled "E." in the passages cited -- his
reproachfulness toward Breuer, his interest in the anal period, his fascination
with bilingual puns, his fear of railway travel, his introspections about the
Riddle of the Sphinx, his discovery of screen memories, and finally his
ambivalence about the termination -- one may surely argue that this was an
especially important case for Freud, one richly charged with transference. It
seems reasonable to believe that Freud suppressed the material on
"E." when it surely must have been planned for publication both in
1896 and again in 1899. This decision is perhaps justifiable on technical
grounds, since as Freud noted he had made numerous mistakes with
"E.," but I believe the decision not to publish also served personal
needs. Freud must have been struck -- as is the modern psychoanalytically
literate reader -- by the remarkable blurring of patient and therapist roles
reflected in the case material. In fact Freud did not publish a case history of
a male patient until the "Rat Man" in 1909, and he was to insist on
the fragmentary and incomplete character of all his published cases.15

Freud's practice had shifted during the 1890s from an essentially
proletarian to a bourgeois clientele, with important consequences for the
development of the notion of transference (Ellenberger, 1970, p. 419). In
"E." I believe Freud found the first of his patients in whom he could
readily see himself, in relation to whom he could observe the full complexity
of psychoanalytic counter-transference. And it is transference that most
fundamentally distinguishes the specific-etiological from the psychoanalytic
theories. Freud is beginning the arduous process of discovering that
psychoanalysis is to a large extent a re-enactment of the patient's
psychodynamics in the therapist-client dyad, rather than a simple recovery of
repressed memories of prior traumas. In "E." Freud found someone who
could, at various times in the period of transition from the seduction theory
to psychoanalysis proper, both verify elements of the existing theory (e.g.,
in the inter-relationship of early childhood, adolescent, and adult emotions)
and inspire essential revisions (e.g., with respect to the primacy of
fantasy over experience).

Freud's later excitement about tracing "E"'s critical childhood
events back to the first 24 months of life shows that the "abandonment"
of the seduction theory three years previously had not lessoned his interest in
the anamnesis. More importantly, the material concerning "E." ties
the theorizing of the period immediately following The Interpretation of Dreams
to that of the etiological papers. Freud's ambivalent emotions concerning both
Jacob's death and E.'s childhood material, and the transferential dynamics of
each, help to explain the realignment of thinking which made possible a
coherent psychoanalytic theory.

The roles of patient and therapist had by this time blurred. This blurring
-- in which the shared fantasy of analyst and analysand takes precedence over
the recovery of factual material in the patient's history -- signifies the new
Freudian position, psychoanalysis. The extent to which (counter-)transferential
merging of analyst and analysand had occurred is, finally, most richly
insinuated by Freud's own dream alluding both to "E."'s interminable
therapy and his own psychodynamics following his father's death.

The Dead Father's Bill

Freud's dream of being billed for hospital expenses which someone had
incurred in 1851 in his birthplace (Freud, 1900, pp. 435-438) is the fourth of
six "Absurd Dreams" presented in his discussion of the dream work in
Chapter Six of The Interpretation of Dreams. These dreams form a set
with strongly overlapping associations (see Grinstein, 1980). Freud himself
draws attention to the most striking similarity among the dreams, the fact that
they deal "by chance, as it may seem at first sight" with dreamers'
deceased fathers (Freud, 1900, p. 426). Freud suggests that he will be offering
"two or three" such dreams, and when he reaches the fourth example he
notes, "Here is another dream about a dead father" (1900, p. 435).
Like other topical collections of dreams presented by Freud, these examples of
absurdity constitute a set of related wishes and ambivalent unconscious
thoughts. In this case, they concern filial relations, paternal death, and
railway travel.

The first of the dreams is that of a male patient whose father has died 6
years earlier. The dreamer sees his father lying in bed gravely injured
following a train accident and is aware of the absurdity of this since the
father is in fact already dead.17 The second dream, which Freud
suggests is "almost exactly similar" (1900, p. 427), concerns his own
father and contains a thought of Jacob's having 'after his death' played a
political part among the Magyars and brought them together politically"
(p. 427). Freud sees an indistinct picture of someone standing on chairs
addressing the Reichstag, and states that he remembered in the dream
"how like Garibaldi [Jacob] had looked on his death-bed, and felt glad
that that promise had come true" (p. 428). The third dream is really a fragment
of the "Count Thun" dream Freud has discussed previously. In it, a
cab driver protests that he cannot drive Freud along a railway line (p. 428).
Freud's associations focus on his own train travels and his frustrated plans to
go to Italy, and he suggests that the "purpose" of the dream's
introduction of an absurdity about train travel is to allude -- via a pun on
"Vorfahren" ("drive up" and "ancestry") --
to the value of progeny. The fourth dream is then presented with the prefatory
comment linking it to the theme of dead fathers.

Freud seems to express in this dream both his ambivalent emotions following
Jacob's death and repressed material from his early Freiberg years. The
reported content of the dream is as follows:

I received a communication from
the town council of my birthplace concerning the fees due for someone's
maintenance in the hospital in the year 1851, which had been necessitated by an
attack he had had in my house. I was amused by this since, in the first place,
I was not yet alive in 1851 and, in the second place, my father, to whom it
might have related, was already dead. I went to him in the next room, where he
was lying in his bed, and told him about it. To my surprise, he recollected
that in 1851 he had once got drunk and had had to be locked up or detained. It
was at a time at which he had been working for the firm of T____. 'So you used
to drink as well?' I asked; 'did you get married soon after that?' I calculated
that, of course, I was born in 1856, which seemed to be the year which
immediately followed the year in question. (Freud, 1900, pp. 435-436).

Freud offers here a dream in which a ghost speaks, a type of dream he cites
repeatedly. These dreams -- all concerned with murderous sibling rivalry and/or
the father's downfall -- share unconscious contents which make their
interpretations mutually relevant and place them at the center of the
self-analytic issues Freud worked through in order to complete The
Interpretation of Dreams. This dream probably occurred in 1899, since it alludes
to "E."'s fifth year of therapy. It was included only in Freud's
final draft of the dream book. Schur (1972, p. 189) suggested that the dream
may have been presented partly as a substitute for the 1898 "big
dream" Fliess had persuaded Freud not to include, apparently on the basis
of its political and/or marital references. Indeed, the famous "Irma"
dream seems to have been chosen by Freud as a less-satisfactory substitute for
this suppressed and subsequently lost dream, requiring him to spread his argument
among several dream-interpretations (see Masson, 1985, pp. 10, 315-316, 363).18

Number play

To this dream of being billed for something his father did before he was
born, and recognizing the absurdity of that as he dreamt it, Freud curiously
associates the number five. The "exciting cause" of the dream
Freud suggests was his reaction to having heard that "a senior colleague
of mine, whose judgment was regarded as beyond criticism, had given voice to
disapproval and surprise at the fact that the psychoanalytic treatment of one
of my patients had already entered its fifth year" (1900, p. 436).
Since Freud goes on to comment that this colleague had taken over paternal
financial duties, that they had later quarreled, and that he had enjoyed this
man's support for 5 years, it is clear that the ambivalent figure in question
is none other than Josef Breuer. Freud then goes on to discuss 5 years
(obscured by his suspicion it might really be 4 years) as the difference
between 1851 and 1856 -- the year of his own birth. Finally he turns to the
number 51. This number is significant as (a) the year 1851 (the relatively
superficial referent), (b) a dangerous age for men, since he imagines several
friends and teachers of his to have died around that age, and (c) the sum of 23
and 28, the Fliessian bisexual period (see Sulloway, 1979; Harris & Harris,
1984). Freud was neurotically preoccupied with death during these years, as
most biographers have noted, and he was haunted by the belief that he would die
by the age of 51. The significance of these interlocked death fears and wishes
underlies many of Freud's dreams during this period, and these in turn form the
basic data of The Interpretation of Dreams.

Freud returns to the dream's number-play a few pages later (in discussing
"intellectual activity in dreams") and draws attention to the dream's
pseudo-syllogistic character:

I asked: 'Did you get married
soon after that?' I calculated that, of course, I was born in 1856, which
seemed to be the year which immediately followed the year in question. All
of this was clothed in the form of a set of logical conclusions. My father had
married in 1851, immediately after his attack; I, of course, was the eldest of
the family and had been born in 1856; Q.E.D. (Freud, 1900, pp. 449-459)

"Q.E.D."? Freud points out that of course each step of this
"logical" conclusion can in fact be explained by latent dream
thoughts. Five years is not long, either for "E." to have awaited a
cure or the marriage he has promised himself at conclusion of treatment. Five
years was not enough for Freud to finish his medical studies, and he had to
reassure himself that, "Even though you won't believe it because I've
taken my time, I shall get through; I shall bring my medical
training to a conclusion" (1900, p. 451).

The other train of latent thought Freud ascribed to his dream's play with
birth dates concerns enrollment at university when, Freud recalled, one had to
give one's father 's first name, and "we students assumed that the Hofrat drew
conclusions from the first name of the father which could not always be
drawn from that of the student himself" (1900, p. 451). Such conclusions
of course included ethnicity and the possible fame of the father, and Freud
acknowledged that he had speculated how much better his academic career would
have gone had he been the son of someone like Meynert. Two of the paternal
figures on whom Freud had vented a great deal of his oedipal ambivalence,
Breuer and Meynert, are strongly associated to the dream, and through them a
network of links is constructed to themes of father-son responsibility and
criticism in matters of intoxication, courtship, and professional advancement.

The very silliness of pursuing so many conclusions from sums and differences
of dates is also a determinant of the dream. Freud's mention of this was brief
and back-handed: He consoled himself that although his speculations about the
retention and later neurotic expression of traumatic influences from the very
earliest period of a child's life seem absurd (and are even parodied by
patients to whom he has mentioned them), they are really correct (1900, p.
451). To which Schur asked, "But who used formulas of this kind?"
(Schur, 1972, p. 186). Fliess, of course, whose biorhythmic speculations are
thereby questioned even as Freud defended his own psychosexual ones. As he
reported at the end of his discussion of the dream, the attack that Freud
imagined was that "My discovery of the unexpected part played by their father
in the earliest sexual impulses of female [sic] patients might well be
expected to meet with a similar [critical] reception" (1900, p. 452).
Hence the dream points to criticism of both Fliess and Jacob Freud, the flawed
intimate friend and the flawed paternal figure.

Rebecca

Freud's discussion of the billing dream also alludes to a major piece of his
own family's drama: Jacob's marriage to "Rebecca" in 1852. The dream
affirms a marriage for Jacob in 1851, and assigns Freud's own birth to the year
after "the year in question." This mysterious second marriage of
Jacob Freud marriage was recorded in the town records of Freiberg, was
witnessed by Jacob's sons Emmanuel and Philipp, but was never mentioned by
Freud himself (see Gicklhorn, 1969). Like all the female figures in Freud's
infancy, Rebecca's significance for him remains obscure. He apparently never
named her in his correspondence and used the name on only one, highly
significant occasion, when he announced to Fliess (on September 21, 1897) that
he no longer believed the seduction theory and suddenly recalled a Yiddish
saying:

After summarizing Freud's network of associations connecting this dream to
Jacob's apparent marriage to the mysterious "Rebekka" and to the
son's worry about his own death, Schur quoted Freud's puzzling use of this
Yiddish anecdote to illustrate his feelings about having abandoned the
seduction theory and asked:

Why just this joke at this time?
Why a joke in which Freud identifies himself with a disgraced woman? And a
joke, the punch-line of which contains the name of this mysterious second wife
of his father? (Schur, 1972, p. 191)

A plausible answer to these related questions is that Freud puzzled in early
childhood about where he fit into his complex and probably quite troubled
family -- Jacob was barely able to put food on the table some years, traveled a
great deal when Freud was an infant, and apparently left Freiberg in disgrace
in 1859. Freud may have imagined himself somehow the outgrowth of this
mysterious and guilty union between his father and Rebecca. As a child he seems
to have sought enlightenment concerning this and other mysteries in the Bible
stories, where Rebecca appears as the Canaanite bride of Isaac, unjustly
accused of fornication and destined to beget Jacob. His self-analysis had
confronted Freud again with these infantile emotions. Freud felt a mixture of
love, anger, and embarrassment when he thought of his dead father, and the
image of Rebecca served these multiple purposes (see Balmary, 1979/1982; Krüll,
1979/1986; McGrath, 1986; Schur, 1972). That the mature Freud remained haunted
by these questions helps to explain why his theorizing in the aftermath of the
seduction theory focused on early childhood dynamics.

The Personal and the Professional Freud

In the year following Jacob Freud's death, Freud became increasingly
preoccupied with the intensive introspection and dream interpretation he and subsequent
biographers have labeled his self-analysis. I believe this term is
justified in the sense that Freud was struggling with serious mental conflicts,
and that their partial resolution in the form of convictions regarding the
childhood sources of his ambition facilitated the major turn of thought from
which most of the core "Freudian" theoretical concepts took form. To
a degree we can never fully know, the unpublished case of "E." linked
this personal synthesis with an emergent theory of psychopathology which became
psychoanalysis. Specifically, I suggest that examining the resonances of
"E."'s case with his own was one key part of Freud's readiness in
1897 to rethink the seduction theory. "E."'s anamnesis followed paths
Freud himself had traveled, into the first 2 years of life and the affects
created then. But Freud finally was forced to acknowledge that ever-richer
understanding of "E."'s emotional life produced neither conviction
that these events had actually occurred, nor remission of the symptoms to which
the psychodynamics appeared to be linked. Ultimately, analyst benefited as much
as patient. Neither was fully freed of symptoms, but in Freud's case the basis
had been laid for a developmental psychology of emotional attachment an a
therapeutic technique in which exploring the attachment to the analyst would be
as important as the recovery of lost memories.

Freud seems to have suffered from a severe neurosis19
during the late 1890s (see Anzieu, 1975/1986), at the very time he was
preparing to transform psychology. His own neurotic suffering, and his shifting
diagnosis of himself, gave Freud strong motivation for self-understanding; and
he both applied assumptions based on his own case to his patients and used
their recalled experiences as a basis for his auto-analysis. Finally, as in the
case of "E.," patient and doctor were not fully distinguishable, as
they merged in support of the universalizing oedipal assumptions making Freud's
a general psychology. The alleged details of this self-analytic process and its
import for Freud's theorizing remain the most fascinating part of Freud's
biography and a crucial base for understanding the early development of his
theories. The very need to make wish-fulfillingness a necessary condition for
the dream echoes the emphasis on early trauma in the seduction theory: In the
original theory a seductive act, and in the revised theory an oedipal wish,
is the precondition of symptom formation.

Freud's preoccupation with his writer's block, a central determinant of
several of his most fully explicated dreams, was a major theme of his
self-analysis. He created impressive theoretical arguments -- on hysteria,
obsession-compulsion, early psychosexual development, and repression -- then
destroyed them with doubt. He wished he could share Fliess's vision of The
Interpretation of Dreams lying open before him (Freud, 1900, p. 172);
worried that his interpretive work was costing him his potency, and perhaps his
health (1900, pp. 477-478); and reflected that it is, after all, intellectual
as well as literal children who make the "crossing" to posterity
possible (1900, p. 453).

Throughout these years of anguished self-analysis and spectacular insight
the patient, persistent "E." was at Freud's side, his importance as a
sounding board analogous at times to Fliess's. Finally, Freud would outgrow
both of these transference figures (see Anzieu, 1975/1986, chapter 6) -- and
Freud would be loathe to fully acknowledge either -- but each left his mark on
theory and practice. "E." involved Freud in new symptom complexes
which stimulated his nosological thinking, provided interpretive material Freud
used to support his own conclusions in The Interpretation of Dreams, and
offered first-hand experience with the transference problems of psychoanalytic
therapy. It is understandable that Freud did not publish this interminable,
path-breaking case, but we must mourn its loss.

Swales, Peter J. (1982). Freud, Minna Bernays, and the conquest of Rome: New
light on the origins of psychoanalysis. New American Review, 1,
1-23.

Swales, Peter J. (1996). Freud, his ur-patient, and their romance of
Oedipus: The role of 'Herr E.' in the conception of psychoanalysis. The
Richardson History of Psychology Seminar, the New York Hospital-Cornell Medical
Center. December 4, 1996.

I am indebted to Susan Schaefer Davis, John M. Hartke, Ann Salyard, and Jane
C. Widseth for comments on an earlier draft.

Note: I owe a special debt to Peter J. Swales (Swales, 1996, and personal
communication, February, 2001) for pointing out to me two costly errors in my attrribution
to “E.” of material included in Freud’s correspondence with Wilhelm Fliess. The
patient for whom the initial “E.” is used throughout the 1950 edition of the
Freud-Fliess correspondence (Bonaparte, Freud, & Kris, 1954, p. 199) and in
the following Standard Edition (Strachey, 1966, v. 1) and Masson (1985) is
given his full last name (“F_____,” see Swales,
1996) by Freud in the letters. He is therefore presumably not the “F.,
whom you know” (Masson, 1985, p. 290; German, p. _) whose lust for a governess
and whose aggressive/erotic childish play with a beetle Freud recounts in
December, 1897. Furthermore, “E.” is almost certainly not the person
whose dream of arrest for infanticide Freud recounts to Fliess in 1897 and
retells in The Interpretation of Dreams in 1900, where he attrubutes it
to “an intelligent jurst of my acquaintance” (Freud 1999, pp. 122-123). That patient’s
full last name is given in the original letters, while for this dreamer Freud
himself uses the initial “F.” This mis-labeling in the three published versions
before the German edition of the unexpurgated Freud-Fiess letters led me (and
many other scholars) to mis-identify him with Freud’s first long-term male
patient (Davis, 1990). I reget the error, and I eagerly await the publication
of Peter Swales’s fine work on the identity and life story of “E.”

Here is the formerly included Marienkäfer passage:

At the end of 1897 Freud reported on parts of two
analytic sessions devoted to the explanation of an anxiety attack suffered by
"E." at the age of 10 as he teased a beetle. The word for beetle, Käfer,
reminded "E." of that for ladybug, Marienkäfer, which he
associated to overhearing that his deceased mother, Marie, had been undecided
about her marriage. Freud noted that in Vienna a woman might be referred to as
a "beetle," and reported that "E."'s "nurse and first
love was a French woman":

Mr E., whom you know, had an anxiety attack at the
age of ten when he tried to catch a black beetle, which would not put up with
it. The meaning of this attack had thus far remained obscure. Now, dwelling on
the theme of "being unable to make up one's mind," he repeated a
conversation between his grandmother and his aunt about the marriage of his
mother, who at that time was already dead, from which it emerged that she had
not been able to make up her mind for quite some time; then he suddenly came up
with the black beetle, which he had not mentioned for months, and from that to
ladybug [Marienkäfer] (his mother's name was Marie); then he laughed out
loud and inadequately explained his laughter by saying that zoologists call
this beetle septem punctata or the equivalent, according to the number
of dots, although it is always the same animal. Then we broke off and the next
time he told me that before the session the meaning of the beetle [Käfer]
had occurred to him, namely, que faire? = being unable to make up one's
mind. Meschugge! (Masson, 1985, p. 290)11

Both the form and the content of this clinical vignette represent a
departure from Freud's earlier style. The actual childhood material is trivial
in itself, no more than a screen for the child's family romance; but the
doubting tone signified an approach-avoidance conflict about his desires which
became "E."'s peculiar neurotic style (see Shapiro, 1965, chap. 2).

2. "Behind him, a shadowy illusion, lay what holds us
all in bondage, the things that are common." Freud quotes these lines from
Goethe's epilogue to Schiller's Lied von der Glocke in discussing the
second of the "Absurd Dreams" of his father having played, after his
death, a political role among the Magyars, in Chapter 6 of The
Interpretation of Dreams (1900, p. 428). Freud recalls, in the dream, how
like Garibaldi his father looked on his death-bed; and he notes that recalling
his father's flushed post-mortem cheeks led him to recall these lines.

3. Rosenblum's very stimulating paper has unfortunately not
been translated, and was published in a hard-to-obtain French journal. It
anticipates some of my remarks about the counter-transferential aspects of
"E."'s treatment for Freud.

5. cf. Erikson. E.H. (1975). A historic friendship: Freud's
letters to Fliess. In Life history and the historical moment. New York: Norton,
pp. 49-81.

6. Kris (Bonaparte, Freud, & Kris, 1950/1954, p. 131,
Note 3) suggested that Freud may also have had "E."'s treatment in
mind when he was struggling to explain repression in the period immediately
following the writing of the "Project" in 1895.

7. The dual concern with whether he could present his
findings in "formulas acceptable to everyone," without at the same
time revealing too much personal information was a perennial concern of
Freud's, as he anticipated negative reaction to his insistence on the role of
infantile sexuality and to the dream as an expression of unconscious wishes. He
expressed this concern in the Fliess correspondence by quoting Goethe's
Mephistopheles to the effect that "The best you know, you may not tell to
boys" (Masson, 1985, pp. 285-299), and he used the phrase in The
Interpretation of Dreams (Freud, 1900) and in his acceptance of the Goethe
prize in 1930.

10. Another evidence of Freud's concern during this period
with abortion as an unconscious issue his explanation of the forgetting of the
word aliquis
in a quote from Virgil has been the subject of great interest since Swales's
argument that it is in fact autobiographical, implicating Freud himself in an
abortion and hence an affair with his sister-in-law, Minna Bernays (cf. Davis, 1990; Rudnytsky,
1987, p. 69; Gay, 1988, pp. 752-753; Swales, 1982).

12. Freud was fascinated with Schliemann's excavation of
Troy, and continued to use archeological analogies for his own psychoanalytic
work throughout his life.

13. For an exploration of the many unresolved oral-period
issues in Freud's self-analysis after Jacob's death, see Salyard (1988).
Freud's attempt to recover details of his early mothering by a series of women
including his biological mother Amalia, his half-brother Emmanuel's wife Maria
(see Krüll, 1979/1986, pp. 123, 234-235), and his nanny seems to have been the
deep core of his self-analysis. These first female objects of Freud's libidinal
attachment and the whole problem of the mother-infant bond lie behind the
residues of the paternal Oedipus complex with which Freud was more consciously
preoccuppied during completion of The Interpretation of Dreams.
Naturally, any case calling these issues to Freud's mind would be rich in
transference material.

14. Strachey (1974, pp. 155-164) found roughly 35 cases
(including "Herr E.") on which Freud commented in print, and a number
of these were never his patients. Strachey cited part of this letter in his
preface to Freud's 1937 "Analysis Terminable and Interminable," but
without mentioning the reference in The Interpretation of Dreams to
Breuer's comment about the interminability of "E."'s treatment.

15. Even the most detailed of Freud's cases has elicited
criticism on grounds of technical procedure and the unconvincing character of
key interpretations (see Bernheimer & Kahane, 1985; Kanzer & Glenn,
1980), and certainly none of them adequately details the mental life of patient
and doctor or the richness of their therapeutic interchange. Freud admitted as
much by the titles he gave his manuscripts. Thus the "Dora" case is a
"Fragment of an Analysis of a Case of Hysteria" (Freud, 1905), the
"Rat Man" case is "Notes upon a Case of Obsessional
Neurosis" (Freud, 1909), and the "Wolf Man" case is "From
the History of an Infantile Neurosis" (Freud, 1918).

17.The author of this first of the "Absurd
Dreams," is probably not "E.," but rather the other of Freud's
male patients mentioned first in 1895 (Masson, 1985, p. 148; Rudnytsky, 1987,
p. 63). This second patient is referred to in The Interpretation of Dreams
as "a young man whose life was made almost impossible by an obsessional
neurosis" (Freud, 1900, p. 260), whose central symptom was an agoraphobic
preoccupation with the thought that if he went out he might murder anyone he
met. The basis of this symptom, Freud asserts, was a conscious impulse at the
age of 7 to murder his father an impulse which in turn "originated much
earlier in his childhood" (p. 260). Freud's second reference to this
obsessional patient concludes the section of Chapter Six on "Intellectual
Activity in Dreams." At that point Freud notes that the patient's
murderous thoughts expressed a "'Cain' phantasy for all men are
brothers" and Freud goes on to suggest that the fear that he might wander
out and commit murder in his sleep had formed the basis for Freud's own
suspicion in this "Hollthurn" dream that he must have changed railway
carriages while sleeping (pp. 457-458). Remarking that he had in fact recently
enjoyed an overnight train trip together with this (now cured) patient, Freud
suggests that he had identified himself with the patient in order to confess a
similar confluence of incestuous and parricidal feeling in his own childhood.

18. On August 1, 1899, Freud wrote:

The loss of the big dream that
you eliminated is to be compensated for by the insertion of a small collection
of dreams (harmless, absurd dreams; calculations and speeches in dreams;
affects in dreams). (Masson, 1985, p. 363)

19. Freud's obsession with death, his railway phobia, and
his hysterical tachycardia have been described by Jones (1953-1957), Schur
(1972), and other biographers. Schur explicitly described Freud's state in the
year Jacob died as a neurotic fear of death. He also called Freud's
20-cigar-a-day habit an "addiction" and faulted Jones for missing the
significance of what Schur argued was a serious heart attack in 1894. According
to Schur, Freud's was a psychosomatic illness with hysterical features,
precipitated by actual stressors -- heart attack, nicotine withdrawal, and the
death of his father.